Hemodynamic, catecholamine, vasomotor and vascular responses: Determinants of myocardial ischemia during mental stress. (15th September 2017)

• Record Type: Journal Article
• Authors: Hammadah, Muhammad; Alkhoder, Ayman; Al Mheid, Ibhar; Wilmot, Kobina; Isakadze, Nino; Abdulhadi, Naser; Chou, Danielle; Obideen, Malik; O'Neal, Wesley T.; Sullivan, Samaah; Tahhan, Ayman Samman; Kelli, Heval Mohamed; Ramadan, Ronnie; Pimple, Pratik; Sandesara, Pratik; Shah, Amit J.; Ward, Laura; Ko, Yi-An; Sun, Yan; Uphoff, Irina; Pearce, Brad; Garcia, Ernest V.; Kutner, Michael; Bremner, J. Douglas; Esteves, Fabio; Sheps, David S.; Raggi, Paolo; Vaccarino, Viola; Quyyumi, Arshed A.
• Is Part Of: International journal of cardiology. Volume 243(2017)
• Page Start: 47
• Page End: 53
• Publication Date: 2017-09-15
• Subjects: MSIMI mental stress induced myocardial ischemia -- CSIMI conventional stress induced myocardial ischemia -- CAD coronary artery disease -- PWV pulse wave velocity -- RHI reactive hyperemia index -- PAT peripheral arterial tonometry -- FMD flow mediated dilation -- RPP rate pressure product -- SBP systolic blood pressure -- DBP diastolic blood pressure -- HR heart rate; Peripheral arterial tonometry -- Vasoconstriction -- Mental stress -- Myocardial ischemia -- Catecholamines -- Endothelial dysfunction -- Arterial stiffness -- Conventional stress test; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2017.05.093
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aims: Mental stress-induced myocardial ischemia (MSIMI) in patients with coronary artery disease (CAD) is associated with adverse cardiovascular outcomes. We aim to assess hemodynamic, neuro-hormonal, endothelial, vasomotor and vascular predictors of MSIMI. Methods and results: We subjected 660 patients with stable CAD to 99mTc sestamibi myocardial perfusion imaging at rest, with mental (speech task) and with conventional (exercise/pharmacological) stress. Endothelium-dependent flow-mediated dilation (FMD), microvascular reactivity [reactive hyperemia index (RHI)] and arterial stiffness [pulse wave velocity (PWV)] were measured at rest and 30-min after mental stress. The digital microvascular vasomotor response during mental stress was assessed using peripheral arterial tonometry (PAT). A total of 106(16.1%) patients had MSIMI. Mental stress was accompanied by significant increases in rate-pressure-product (heart rate x systolic blood pressure; RPP), epinephrine levels and PWV, and significant decreases in FMD and PAT ratio denoting microvascular constriction. In comparison to those with no MSIMI, patients with MSIMI had higher hemodynamic and digital vasoconstrictive responses (p < 0.05 for both), but did not differ in epinephrine, endothelial or macrovascular responses. Only presence of ischemia during conventional stress (OR of 7.1, 95%CI of 4.2, 11.9), high hemodynamic response (OR for RPP response ≥ vs < ROC cutoff of 1.8, 95%CI of 1.1, 2.8), and high digital vasoconstriction (OR for PAT ratio < vs ≥ ROC cutoff of 2.1, 95%CI of 1.3, 3.3) were independent predictors of MSIMI. Conclusion: Ischemia during conventional stress testing and hemodynamic and vasoconstrictive responses to mental stress can help predict subjects with CAD at greater risk of developing MSIMI.